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42 Journal of Research in Medical Sciences 2004; 1: 42-51

Review Article

A Review on Dental Amalgam Corrosion and Its Consequences

M. Fathi PhD*, V. Mortazavi DDS**

ABSTRACT

Dental amalgam is still the most useful restorative material for posterior teeth and has been successfully used for

over a century. Dental amalgam has been widely used as a direct filling material due to its favorable mechanical

properties as well as low cost and easy placement. However, the mercury it contains raises concerns about its

biological toxicity and environmental hazard. Although in use for more than 150 years, dental amalgam has

always been suspected more or less vigorously due to its alleged health hazard.

Amalgam restorations often tarnish and corrode in oral environment. Corrosion of dental amalgam can cause

galvanic action. Ion release as a result of corrosion is most important. Humans are exposed to mercury and other

main dental metals via vapor or corrosion products in swallowed saliva and also direct absorption into blood

from oral mucosa. During recent decades the use of dental amalgam has been discussed with respect to potentialtoxic effects of mercury components.

In this article, the mechanisms of dental amalgam corrosion are described and results of researches are reviewed.

It finally covers the corrosion of amalgams since this is the means by which metals, including mercury, can be

released within oral cavity.

Keywords:Dental amalgam, Amalgam corrosion, Biocompatibility, Mercury release, Amalgam restoration

ne of the primary conditions of anymetal used in the mouth is that it

must not produce corrosionproducts that will be harmful to the body 1.Corrosion is a chemical or electrochemicalprocess through which a metal is attacked bynatural agents, resulting in partial orcomplete dissolution, deterioration, or

weakening of any solid substance 2.Oral environment is very susceptible to

corrosion products formation. Mouth isalways moist and is continually subjected tofluctuations in temperature. Food and

liquids ingested have wide ranges of pH.Acids are released during the breakdown offoodstuffs. All of these environmentalfactors contribute to the degrading processknown as corrosion 2.

Tarnish is a surface discoloration on apiece of metal. In oral cavity, tarnish oftenoccurs from the formation of hard and soft

deposits on the surface of the restoration.The soft deposits are plaques and films

composed mainly of microorganisms andmucin. Surface discoloration may also ariseon a metal from the formation of thin films,such as oxides, or sulfides. Tarnish is anearly indication of corrosion 1.

Corrosion in the specific sense is notmerely a surface deposit but is an actualdeterioration of a metal by reaction with itsenvironment. It causes severe and cata-strophic disintegration of the metal body.

This disintegration of the metal may occur

through the act of moisture, atmosphere,acids, alkalies or certain chemicals.Various sulfides, such as hydrogen or

ammonium sulfide, corrode silver, mercury,and similar metals present in amalgam 2, 3

Water, oxygen, and chloride ions are presentin saliva and contribute to corrosion attack.

* Assistant Professor, Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran

**Associate Professor, Faculty of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran

O

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A Review on Dental Amalgam Corrosion and Its Consequences Fathi et al.


Because of their different chemicalcompositions, the different phases of anamalgam have different corrosion potentials.Electrochemical measurements on purephases have shown that the Ag2Hg3 phase

has the highest corrosion resistance,followed by Ag3Sn, Ag3Cu2, Cu3Sn, Cu6Sn5,and Sn7-8Hg. The following compoundshave been identified on dental amalgams inpatients: SnO, SnO2, Sn4(OH)6Cl2, Cu2O,CuCl2.3Cu (OH) 2, CuCl, CuSCN and

AgSCN 9.In a low-copper amalgam system, the

most corrodible phase is the tin-mercury, or2 phase. Even though a relatively smallportion (11% to 13%) of the amalgam mass

consists of the 2 phase, in time and in anoral environment the structure of such anamalgam will contain a higher percentage ofcorroded phases. On the other hand, neitherthe nor the 1 phase is corroded as easily.Corrosion results in the formation of tinoxychloride from the tin in the 2 and alsoreleases mercury, as shown in the followingequation:Sn7-8 + 1/2 O2 + H2O + Cl

- = Sn4 (OH)6Cl2+ Hg

The reaction of the released mercury withunreacted can produce additional 1 and 2

9,10.The high copper amalgam alloys do not

have any2 phase in the final set mass. The phase formed with high copper alloys showsbetter corrosion resistance. However, isthe least corrosion resistant phase in highcopper amalgams, and a corrosion product,CuCl2.3Cu (OH) 2, has been associated withstorage of amalgams in synthetic saliva, asshown below:

Cu6Sn5 + 1/2 O2 + H2O + Cl-

= CuCl2. 3Cu(OH) 2 + SnOPhosphate buffer solutions inhibit the

corrosion process, thus saliva may providesome protection for dental amalgams againstcorrosion 9, 10.

The significance of dental amalgam

corrosion

Corrosion of dental amalgam can causegalvanism and galvanic action besides the

damaging of restorative metal

1, 3

. Thegalvanic shock is well known in dentistry

and the effect of galvanic current on thepatient has been discussed2. Thepostoperative pain due to galvanic shock canbe a real source of discomfort to anoccasional patient 2, 3. The ion release as a

result of corrosion is more important anddiscussion about this matter has beencontinued 5.

Prolonged attempts to evaluate anddetermine dental amalgam corrosion havebeen made during recent decades and theresults have been reported 11-14. Prominentsuccesses have been obtained aboutimprovement of amalgam corrosionresistance and optimizing amalgamcorrosion behavior 15. Research and efforts

have continued and especially most attentionwas concentrated on effects of mercury onthe human body and dental amalgambiocompatibility during the last decade 16-24.

Mercury used in dental amalgams,however, raises concerns about its biologicaltoxicity and environmental hazard 25.

Although in use for more than 150 years,dental amalgam has been suspected more orless vigorously as a dental restorationmaterial due to its alleged health hazard.

Humans are exposed to mercury and othermain dental metals (Ag, Sn, Cu, and Zn) viavapor, corrosion products in swallowedsaliva, and direct absorption into blood fromoral mucosa. Dental amalgam fillings are themost important source of mercury exposurein general population. Local, and in someinstances, systemic hypersensitivity reactionsto dental amalgam metals, especiallymercury, occur with a low incidence amongamalgam bearers. Experimental and clinical

data strongly indicate that these and othersub-clinical systemic adverse immunologicalreactions to dental amalgam in humans arelinked to certain MHC genotypes, and affectonly a small number of exposed individuals 26.

The presence of amalgam fillings doesnot appear to affect general health ofpatients. In summary, it can be stated thatepidemiological studies of amalgam bearershave not detected increased incidence ofcancer, cardiovascular disease, diabetes, early

death or subjectively reported ailments.Furthermore there is no evidence to support

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Journal of Research in Medical Sciences 2004; 1: 42-51 45

the contention that mercury exposure fromamalgam filling could cause neurologicaldisease, multiple sclerosis, motor neurondisease, Alzheimers disease, Parkinsonsdisease, chronic fatigue syndrome, renal

disease, immunological dysfunction, effectson the fetus, increased antibiotic resistance,and adverse effects on general health 21.

It has been suggested that the use ofamalgams should be discontinued but some27 believe that amalgam restorations are quitesafe. Amalgam restorations will continue tobe, until esthetic can match amalgamslongevity, ease of placement, and versatility10.

Concerns have been expressed overtoxicity of dental amalgam, in particular with

respect to marginal fracture, surfacedegradation, corrosion, release of corrosionproducts (particularly mercury) andbiocompatibility28.

Many attempts have been made in orderto evaluate amalgam corrosion behavior.

Various types of tests and experimentalmethods have been used to determine thecorrosion behavior of commercial amalgamsand the results have been reported 29-31.Evaluation of tarnish in dental amalgams has

been performed32

and immersion tests havebeen used for determining the mercury ionrelease values 33. One of the most importanttests for evaluating amalgam corrosionbehavior is electrochemical test and manystudies were done with this method 34-37since it was proved that the electrochemicaltests are useful, valid and reliable 28.

In vivo tests and clinical studies havebeen utilized to evaluate the corrosion,tarnish, and marginal degradation of dental

amalgam restorations38,39

and the correlationbetween the number of amalgam surfacesand mercury levels in plasma and urine 39.

Researchers have studied the mercuryvaporization from corroded dental amalgam,the release of mercury and the release ofmercury vapor from amalgam restorations 40-42. Concerns have been expressed over therelation of oral mucosal lesions and amalgamrestoration 43, and mercury-specificlymphocytes 44.

It has been reported that dental amalgamfillings are free of toxic reactions on patients16

and allergic contact eczema observed in afew individuals is the only problem inconnection with the use of amalgam filling17.On the other hand, since the toxicologicalconsequences of exposure to mercury from

dental amalgam is a matter of debate inseveral countries, researchers have tried toobtain data on mercury concentrations insaliva and feces before and after removal ofdental amalgam fillings 18. Before removal,the median mercury concentration in feces

was more than 10 times higher than samplesfrom an amalgam free reference groupconsisting of 10 individuals. Sixty days afterremoval, the median mercury concentration

was still slightly higher than in samples from

the reference group. It was concluded thatamalgam fillings are a significant source ofmercury in saliva and feces 18.

Health risks from amalgam filling are asubject of controversy. In Germany, it is notadvised to use amalgam filling during breast-feeding 22. The concentration of mercury inhuman breast milk collected immediatelyafter birth showed a significant association

with the number of amalgam fillings as wellas with the frequency of meals. Urine

mercury concentration correlated with thenumber of amalgam fillings and amalgamsurfaces. In the breast milk after 2 monthsof lactation, the concentrations were lowercompared with the first sample range and

were positively associated with the fishconsumption but no longer with the numberof the amalgam fillings. Accordingly,additional exposure to mercury of breast-fedbabies from maternal amalgam fillings is ofminor importance compared to maternal

fish consumption22

.For high copper amalgam, the release ofelements increased with time, except for Cuand Sn in the solution with 100 mMphosphate, indicating that phosphateinhibits corrosion of Cu-Sn phases. Releaseof corrosion products from the high copperamalgam was more dependent on thepresence of phosphate than theconventional amalgam 33.

During recent decades, the use of dental

amalgam has been discussed with respect topotentially toxic effects of mercury

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component 17. Therefore, it has beennecessary to study more about the dentalamalgam corrosion and its biocompatibility.Many researches have been performed inorder to obtain more data about the tarnish,

corrosion behavior, biocompatibility, andcharacteristics of dental amalgam all over theworld and in Iran 45-60.

It was shown that the degree of tarnishand the resulting discoloration of threecommercial dental amalgams used in Iran,

were dependent on parameters such asindividuals oral environment, oral hygiene,position of the restoration, clinicalperformance, and to a certain extent, on thetype of commercial dental amalgam 4, 47, 48.

Tarnish and corrosion of three commercialdental amalgams used in Iran namelySybraloy, Cinaalloy, and SolilaNova, wereinvestigated and evaluated by utilizing in

vitro tests. The corrosion and dissolutionrate of the three commercial dentalamalgams were studied in 0.9 wt % NaClsolution, artificial saliva and Ringerssolution by Potentiodynamic polarizationtechnique. The corrosion potential and thecorrosion current density of each type of

commercial amalgam were found to beaffected by the nature of electrolyte, as wellas the pre-immersion time. However, theorder of corrosion potential and corrosioncurrent density of the three commercialdental amalgams examined, were found tobe independent of the type of electrolyte47-51.

The mercury release from each type ofcommercial amalgams into sodium chloride,sodium sulfide in long-term testing was notsignificant. On the other hand, the mercury

release from each type of commercialamalgams into artificial saliva solution inshort-term test (the initial mercury release)

was considerably significant 4, 52-54.Four different types of commercial

amalgam alloys with various chemicalcompositions and particle shapes (lathe cut,spherical, spheroids) namely; Sybraloy,Oralloy, Cinaalloy, and Cinalux were studied.

Adequate samples of each type of theamalgams were prepared. After triturating

and condensation, the samples of each typewere divided into three groups and using

one of the following three procedures;carving, carving-burnishing, carving-burnishing-polishing. Structural characteriz-ation techniques including SEM were usedto investigate the surface morphology of

amalgam samples55-57

. Electrochemicalpotentiodynamic tests were performed inphysiological solution in order to determinethe corrosion behavior of differentamalgams as an indication of biocom-patibility58-60.

It was shown that shape of particles andclinical procedures could affect the finalsurface roughness of each type ofcommercial dental amalgam. There was astatistically significant difference between

the mean surface roughnesses of threedifferent groups of each type of amalgam.The carved group of each type of dentalamalgam showed the most surfaceroughness while the carved-burnished-polished group had the most surfacesmoothness 55,57. The results showedstatistically significant differences betweenthe mean corrosion current density values ofthe three different groups of each type ofthe commercial amalgam (Figures 1 and, 2).

The polished group of each type ofcommercial amalgam possesses the lowestcorrosion current density and the carvedgroup shows the highest corrosion currentdensity. This trend was not affected by thechemical composition of commercialamalgams. The carved Sybraloy possessesthe lowest corrosion current densitycompared to the other three types ofamalgams. The carved group of theCinaalloy also possesses the highest

corrosion current density (Figure 3). Thesimilar trend can be observed for the carved-burnished and the carved-burnished-polished group of four brands of amalgam(Figure 4). It was concluded that the clinicaloperations and procedures could be effectiveon tarnish and corrosion of amalgam besidessurface plaque accumulation and recurrenceof tooth caries 57-60.

Conclusion

Todays amalgams are much more durableand reliable than what was available in 1895

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when Black began his studies. In fact, theyare now more durable than they used to be30 years ago.

Although in use for more than 150 years,dental amalgam has been suspected more or

less vigorously as a dental restorationmaterial due to its alleged health hazard. Itconsiders the possible toxic and allergiceffects, which could occur as a result ofexposure to mercury from dental amalgam.

The main toxic effects are thought to beneurotoxicity, kidney dysfunction, reducedimmunocompetence, effects on oral andintestinal bacterial flora, fetal and birtheffects and effects on general health.

In general, like X-rays or fluoridetreatments, the therapeutic advantages ofdental amalgams seem to outweigh therelatively small risk of adverse effects.Banning mercury-based fillings and

removing them would not only result inserious losses of dentition, but substitutionof an alternate material will carry the burdenof proving that the substitute does notcontain potentially toxic ingredients atperhaps the same or greater level of risk as

well.

Figure 1. Potentiodynamic polarization curves of the carved (C), carved-burnished (CB), and carved-

burnished-polished (CBP) groups of the Sybraloy amalgam in the normal saline solution at 37 C.

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Figure 2. Potentiodynamic polarization curves of the carved (C), carved-burnished(CB), and carved-burnished-polished (CBP) groups of the Cinaalloy amalgam in the

normal saline solution at 37 C.

Figure 3. Potentiodynamic polarization curves of the carved group of four types ofcommercial amalgams in the normal saline solution at 37 C.

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Figure 4. Potentiodynamic polarization curves of the carved-burnished-polished

group of four types of amalgams in the normal saline solution at 37 C.

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